title: A modified approach to component separation using biologic graft as a load-sharing onlay reinforcement for the repair of complex ventral hernia.
abstract: BACKGROUND
  Components separation has been proposed as a means to close large ventral hernia without undue tension. We report a modification on open components separation that allows for the incorporation of onlaid noncrosslinked porcine acellular dermal matrix (Strattice, LifeCell Corp, Branchburg, NJ) as a load-sharing structure.
  
  
  METHODS
  This was a retrospective case series including all cases using Strattice from July 2008 through December 2009. Data evaluated included patient demographics, comorbidities associated with risk of recurrence, hernia grade, and postoperative complications. The primary outcomes were hernia recurrence and surgical site occurrences.
  
  
  RESULTS
  There were 58 patients; 60.8% presented with a recurrent incisional hernia. Average length of follow-up was 384 days. There were 4 hernia recurrences (7.9%). Complications included surgical site infection (20.7%), seroma (15.5%), and hematoma (5%) requiring intervention. Four deaths occurred in the series due to causes unrelated to the hernia repair, only 1 within 30 days of operation.
  
  
  CONCLUSIONS
  This series demonstrates that components separation reinforced with noncrosslinked porcine acellular dermal matrix onlay is an efficacious, single-stage repair with a low rate of recurrence and surgical site occurrences.
authors.affiliation: 1University of Maryland School of Medicine, Baltimore, MD, USA.
authors.forename: Devinder P
authors.initials: DP
authors.lastname: Singh
authors.forename: Hamid R
authors.initials: HR
authors.lastname: Zahiri
authors.forename: Brian
authors.initials: B
authors.lastname: Gastman
authors.forename: L H
authors.initials: LH
authors.lastname: Holton
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Stromberg
authors.forename: Karan
authors.initials: K
authors.lastname: Chopra
authors.forename: Howard D
authors.initials: HD
authors.lastname: Wang
authors.forename: Alexandra
authors.initials: A
authors.lastname: Condé Green
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Silverman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000009:adverse effects / Q000627:therapeutic use*; D003094:Collagen / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006555:Hernia, Ventral / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies
chemical_list: D001672:Biocompatible Materials; C568444:strattice; D003094:Collagen
keywords: Strattice; components separation; load sharing; onlay reinforcement; ventral hernia